UHC Problems

Hello all,
called UHC and spoke to 4 different case cooridation people and two did not know what they were talking about and two said that my case had to be appealed to my employer since they are self funded. They claim that they were sending me a letter stating that this is what I have to do. They provided me with my HR department phone number and address which is in another state. I gave them a call and was told that they do not handle my appeal. What my HR does is be the advocate for me if I did not like UHC decision. So I'm thinking they have denied my claim again. So I filed a complaint against them with my emplyor and they are going to investigate this and I should hear something within 48 hours. What a mess. So please continue to keep me in your prayers on this.  I hope that we can get to the bottom of this soon.

First and foremost what Surgery were you denied for. Secondly if you are going after VSG surgery UHC will not approve you no matter how many times you appeal I found this out on my own i was denied 3 times and then decided on the realize band.  Third UHC requires a 6 month doctor supervised diet, 5 year BMI of over 40 or 35 with 2 or more co morbidities, Psychologist visit, a letter from your PCP, Blood work when you go see your PCP. Also if your company has less than 100 employees there might be a stipulation in your policy about not paying for WLS. When I was getting ready to start on everything back in March i called UHC 6-8 times and got different answers everytime I called so make them send it to you in writing and if they say they don't do that ask to speak to a supervisor and she will send you a copy out of their book. The main thing is tell us what you were denied for. I do see by your profile that you have done all that you are suppose to do for now and all of that is required.

I feel your pain. I have UHC as well and I'm *trying* to have RNY. I called them as soon as the doctor even breathed a word of WLS and they said i did NOT have to have the 6 month diet. Two weeks after we get all of the testing done and submit the paperwork, they finally tell me "oh. We don't approve that here. You have to go through this other company." I go to the other company and they tell me that my *employer* has a policy that I need the 6 month diet. So now I'm appealing to my employer.

I would really like to find the guy that has a clue in all this. I think he's probably running through the halls with a red crayon coloring all the walls that he can find.

I'll pray for both of us